Shingles
Shingles is a painful rash that is caused by the varicella zoster virus. It affects nearly one million Americans per year. It usually appears as a band or strip of blisters on one side of the body that starts at the spine and curves around to the front of the chest, down one arm or leg or onto the face.
Shingles is a reactivation of the chicken pox virus (varicella zoster virus or VZV). After having chicken pox, the virus retreats into the nerves that come from the spinal cord. Years later, it reactivates and travels down a nerve. Although, the actual inciting event is not always known, stress, sunburn and other illnesses are potential reasons. Shingles is contagious The virus develops into shingles for people who have had chicken pox and develops into chicken pox for those who have not had it. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.
Symptoms for shingles include:
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Fever, achiness or headache may precede the rash
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Pain, burning, numbness or tingling on one side of the body along a narrow strip of skin. The pain often precedes any other symptoms.
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A rash that appears a few days after the pain at the same site as the symptoms. It is classically characterized by blisters that break open and then crust over.
Occasionally, patients with shingles have no rash, only the pain, burning or tingling.
Shingles is diagnosed based on a medical history and physical examination. If you suspect you may have shingles either from symptoms or a rash, it is important to contact your medical professional quickly.
Shingles usually resolves in 2 to 3 weeks unless there are complications. Approximately 10% to 20% of patients experience prolonged and often severe pain and burning after the rash is healed. This is called post-herpetic neuralgia or PHN. This can be severe and life-altering and require pain medications and other therapies. PHN predominantly affects Caucasians over 60, those with chronic medical problems and those who are immunosuppressed. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia.
Early treatment can reduce the pain and severity of the episode. Medications that may be used to shingles include:
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Antiviral drugs- used to combat the virus, and include acyclovir, valacyclovir and famciclovir. These drugs can shorten the course and reduce the likelihood of post-herpetic neuralgia
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Oral Steroids- used reduce pain and inflammation, and most importantly, reduce the likelihood of post-herpetic neuralgia
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Topicals- capsaicin (chili pepper extract) is used to reduce the pain of PHN as well as topical anesthetics such as lidocaine
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Medications to treat pain- used for patients with severe/debilitating pain and/or those with post-herpetic neuralgia; these include anti-depressants (amitriptyline) and anti-seizure medications (gabapentin) that treat nerve pain as well as standard pain medications (opioids)
Vaccination
The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.
